Can meniscus refixation prevent early development of arthrosis in the knee joint? Long-term results

This retrospective study presents the long-term results after meniscal repair with emphasis on early-development of osteoarthritis in the knee. From 1984 to 1996 meniscal repair using the inside-out technique was performed on 54 patients. 25 patients had an isolated tear of the meniscus and 29 additionally a tear of the anterior cruciate ligament (ACL, combined injury). 18 patients of those with a combined injury showed a stable knee during clinical follow-up. A separate evaluation of this group was carried out. The mean follow-up was 6.4 years. 22 patients were examined over a period of 2-5 years (mean 3.5) after surgery, 32 patients after 5 years (mean 8.9). The clinical evaluation was carried out using IKDC, Tegner activity scale, Lysholm, and Tapper and Hoover-Score as well as the Fairbank radiographic evaluation. According to the Fairbank's evaluation the results show that up to 5 years after meniscal repair only minimal radiographic changes were detectable. In only 21% of patients with an isolated meniscal lesion and in 13% of those with a stable knee after a combined injury beginning of osteorathritic changes were noted more than 5 years postoperatively. Early osteoarthritic changes were present within 5 years after surgery in non-stable knees (untreated rupture, suturing). Patients with meniscal repair mostly regain their original Tegner activity level and good to very good results in the clinical scores. However, the results clearly indicate that the success of meniscal repair depends on the stability of the knee. Thus, meniscal repair in stable knees is recommended to prevent early development of osteoarthritis.     

Two to nineteen years follow-up of arthroscopic meniscal repair using the outside-in technique: a retrospective study

PURPOSE: To perform a long-term follow-up evaluation of the outside-in technique of arthroscopic meniscal repair. TYPE OF STUDY: Retrospective study. METHODS: Between the years 1986 and 2002, 93 cases of arthroscopic meniscal repair using the outside-in technique have been operated by the senior author (F.L.). Forty-one patients were available for the follow-up evaluation with a mean follow-up of 11.71 years. The International Knee Documentation Committee (IKDC), the modified Lysholm score, the SF-36 (short form 36) health survey score, a visual analogue scale (VAS) for assessment of patients' satisfaction and another VAS for assessment of patients' pain were used retrospectively to evaluate the patients. We also used the Kellgren and Lawrence (K/L) classification of osteoarthritis to evaluate the preoperative X-rays and the X-rays done at the time of the follow-up evaluation. Failure was defined as having a meniscectomy procedure post-operatively. Results: From the 93 patients, 52 could not be retrieved for the follow-up evaluation, while 41 were available for it; 36 patients were clinically successful and 5 were considered as failure. Thirty-six patients were classified as grade "A" in the objective IKDC score, mean modified Lysholm score was 87.29 (SD 16.43), while mean SF-36 score was 85.73 (SD 14.17). The results of the VAS for operation satisfaction ranging from -10 to +10 revealed that the mean of the answers was 8.05 (SD 2.99). The results of the VAS for pain ranging from 0 to 10 revealed that the mean of the patients' pain at the time of the follow-up evaluation was 1.8 (SD 2.42). Twenty out of 24 (only 24 preoperative X-rays were available) were classified as having no osteoarthritis pre-operatively, whereas only 12 out of the 41 patients were classified as having no osteoarthritis (normal) at the time of the follow-up evaluation according to the K/L classification which indicates progression of osteoarthritis. No complications related to the outside-in arthroscopic meniscal repair procedure were reported. CONCLUSION: We conclude that arthroscopic meniscal repair using the outside-in technique is a safe surgical procedure with a good clinical outcome.     

An MRI-based suspension bridge sign can predict an arthroscopically favorable meniscal healing following the medial meniscus posterior root repair

BackgroundMedial meniscus (MM) posterior root repairs show favorable clinical outcomes in patients with MM posterior root tears (MMPRTs). However, there is no useful magnetic resonance imaging (MRI) finding to determine a functionally good meniscal healing following MM posterior root repairs. We hypothesized that a characteristic postoperative MRI finding can predict a good meniscal healing following pullout repairs. The aim of this study was to investigate a clinical usefulness of several MRI findings for estimating an actual meniscal healing following MMPRT repairs.MethodsFifty eight patients who had a posteromedial painful popping of the injured knee and underwent an arthroscopic pullout repair for the MMPRT were included. Arthroscopic meniscal healing was assessed according to the Furumatsu scoring system at 1 year postoperatively. We evaluated postoperative MRI-based meniscal healing using signal intensity, continuity, suspension bridge-like sign of the MM posterior root, and MM medial extrusion on coronal images. Postoperative clinical outcome evaluations were performed at second-look arthroscopy.ResultsTwenty three patients showed good arthroscopic healing scores (≥7 points). Thirty five patients had moderate/poor arthroscopic healing scores (<7 points). At 1-year follow-up period, clinical outcome scores were significantly higher in the good healing group than in the moderate/poor healing group. A characteristic meniscal shape, termed “suspension bridge sign”, was highly observed in the good meniscal healing group (83%) compared with in the moderate/poor healing group (26%, P < 0.001). High signal intensity and continuity of the MM posterior root and MM medial extrusion showed no differences between both groups.ConclusionsOur study demonstrated that the MRI-based suspension bridge sign can predict an arthroscopically favorable meniscal healing following the MM posterior root repair. The suspension bridge-like MRI finding of the MM would be a useful indicator to evaluate the actual meniscal healing in patients who underwent pullout repairs for MMPRTs.     

Arthroscopic superior labrum anterior-posterior repair in military patients

The purpose of this retrospective study was to determine the efficacy of arthroscopic superior labrum anterior-posterior (SLAP) repair in a military population. In this study, 27 patients (of 30 consecutive patients) who had suture anchor repair of a type II SLAP lesion were evaluated at a mean of 30.5 months postoperatively. Fifteen patients had isolated tears, whereas twelve also had a concomitant diagnosis. At follow-up, the overall mean American Shoulder and Elbow Surgeons score was 86.9 points and the mean University of California, Los Angeles score was 30.4 points. The results were excellent in 4 patients, good in 20, and fair in 3. Of the patients, 96% returned to full duty (mean, 4.4 months). Patients treated for concomitant diagnoses and a SLAP tear had significantly higher American Shoulder and Elbow Surgeons scores and tended to have higher University of California, Los Angeles scores than those treated for an isolated SLAP tear. The findings indicate that arthroscopic SLAP repair in military patients results in a high rate of return to duty. The results suggest that concomitant shoulder pathology should be treated at the time of SLAP repair.     

Arthroscopic anterior cruciate ligament reconstruction using a hamstring graft with interference screw fixation.

BACKGROUND AND AIMS: This study assessed the clinical and radiographic results 3 to 8 years after an arthroscopic ACL reconstruction using a hamstring graft with interference screw fixation on femoral and tibial sites. MATERIAL AND METHODS: Seventy-six of 100 patients, who underwent an arthroscopic ACL reconstruction, could be re-examined with a mean follow-up of 5 years. RESULTS: The mean Tegner activity score was 4 (scale: 0 to 10) before surgery, and 5 at the follow-up. Fifty-four patients (78%) achieved a satisfactory result in the IKDC rating. The mean Lysholm score was 85 (scale: 0 to 100), the score being better in patients without meniscal resection than those with (P = 0.04). The mean side-to-side difference in anterior-posterior knee laxity was 1.8 mm, and 62 patients (90%) had good stability. Sixty-four patients (93%) had normal range of motion of the knee. Twelve patients (46%) with meniscal resection had osteoarthritic changes, compared with only 8 of those (20%) without meniscal resection (P = 0.03). CONCLUSIONS: This medium-term follow-up study showed that good stability and function and normal range of motion of the knee can be achieved in majority of the patients who have undergone an ACL reconstruction with a hamstring graft and interference screw fixation.     

Two-year follow-up of meniscal repair using a bioabsorbable arrow

Purpose: The value of meniscal repair is well established. Several all-inside arthroscopic techniques have become available to achieve this goal. One such technique involves the use of a biodegradable polylactic acid tack, which has made repair technically easier to perform. This study evaluates the 2-year results of arthroscopic meniscal repair using this device. Type of Study: Retrospective case series. Methods: We reviewed charts of 38 patients who had undergone 39 meniscal repairs with the bioabsorbable arrow. All procedures were performed by one of 4 fellowship-trained sports medicine orthopaedic surgeons in 1 of 2 affiliated hospitals, with a minimum follow-up of 2 years. Review consisted of evaluation of patient records, interview, and clinical examination by an independent examiner. Lysholm and Tegner knee scores were recorded. Complications and clinical failure, defined as reoperation, were noted. Results: The average age of the patients was 29.9 years. The ratio of medial to lateral meniscal repair was 5:1. Twenty-one patients underwent concurrent anterior cruciate ligament reconstruction, and in this subgroup, there were no clinical failures. In the remaining group, isolated meniscal repairs in stable knees, the clinical failure rate was 7% (2 reoperations). Local soft-tissue complications occurred in 31.6% of patients, including 2 with arrow migration through the skin. These symptoms typically resolve over several months. Conclusions: The availability of sutureless all-inside absorbable techniques for meniscal repair has made the procedure technically easier to perform arthroscopically. In our patients, local complications related to device migration, device prominence, and soft-tissue inflammation associated with absorption of the device were common (31.6%). These complications were usually transient. We emphasize the importance of selecting the correct length of device so as to minimize these effects. As with other meniscal repair techniques, a higher success rate was found in knees undergoing concurrent anterior cruciate ligament reconstruction. Our results show a clinical success rate using an absorbable all-inside technique with an absorbable device comparable to reported results using established inside-out techniques.     

Isolated revision meniscal repair – failure rates,clinical outcome,and patient satisfaction

Background

Failure of isolated primary meniscal repair must be expected in approximately 10–25% of cases. Patients requiring revision surgery may benefit from revision meniscal repair, however, the results of this procedure remain underreported. The purpose of this study was therefore to evaluate the outcome and failure rates of isolated revision meniscal repair in patients with re-tears or failed healing after previous meniscal repair in stable knee joints.

Methods

A chart review was performed to identify all patients undergoing revision meniscal repair between 08/2010 and 02/2016. Only patients without concomitant procedures, without ligamentous insufficiency, and a minimum follow-up of 24?months were included. The records of all patients were reviewed to collect patient demographics, injury patterns of the meniscus, and details about primary and revision surgery. Follow-up evaluation included failure rates, clinical outcome scores (Lysholm Score, KOOS Score), sporting activity (Tegner scale), and patient satisfaction.

Results

A total of 12 patients with a mean age of 22?±?5?years were included. The mean time between primary repair and revision repair was 27?±?21?months. Reasons for failed primary repairs were traumatic re-tears in 10 patients (83%) and failed healing in two patients (17%). The mean follow-up period after revision meniscal repair was 43 (± 23.4) months. Failure of revision meniscal repair occurred in 3 patients (25%). In two of these patients, successful re-revision repair was performed. At final follow-up, the mean Lysholm Score was 95.2 (± 4.2) with a range of 90–100, representing a good to excellent result in all patients. The final assessment of the KOOS subscores also showed good to excellent results. The mean Tegner scale was 6.8?±?1.8, indicating a relatively high level of sports participation. Ten patients (83%) were either satisfied or very satisfied with the outcome.

Conclusion

In patients with re-tears or failed healing after previous isolated meniscal repair, revision meniscal repair results in good to excellent knee function, high level of sports participation, and high patient satisfaction. The failure rate is slightly higher compared to isolated primary meniscal repair, but still acceptable. Therefore, revision meniscal repair is worthwhile in selected cases in order to save as much meniscal tissue as possible.

     

The Results of All-Inside Meniscus Repair Using the Viper Repair System Simultaneously with Anterior Cruciate Ligament Reconstruction

Background

Meniscus tears are commonly associated with anterior cruciate ligament (ACL) ruptures. It is essential to repair meniscal tears as much as possible to prevent early osteoarthritis and to gain additional stability in the knee joint. We evaluated the results of arthroscopic all-inside repair using the Meniscal Viper Repair System (Arthrex) on meniscus tears simultaneously with ACL reconstruction.

Methods

Nineteen out of 22 patients who were treated with arthroscopic all-inside repair using the Meniscal Viper Repair System for meniscus tear associated with ACL rupture were evaluated. ACL reconstructions were performed at the same period. The mean follow-up period was 16.5 months (range, 12 to 24 months). The clinical results of the meniscus repair were evaluated by symptoms (such as catching or locking), tenderness, effusion, range of motion limitation, and the McMurray test. Clinical success was defined by negative results in all five categories. The Hospital for Special Surgery (HSS) score was evaluated. Objective results were evaluated with secondary look arthroscopy or magnetic resonance imaging (MRI). The MRI results were categorized as completely repaired, incompletely repaired, and failure by Henning''s classification. The results of second-look arthroscopy were evaluated with the criteria of meniscal healing.

Results

The clinical success rate was 95.4% and the HSS scores were 93.9 ± 5.4 at the final follow-up. According to Henning''s classification, 15 out of 18 cases showed complete healing (83.3%) and two cases (11.1%) showed incomplete healing. Seventeen out of 18 cases that underwent second-look arthroscopy showed complete healing (94.4%) according to the criteria of meniscal healing. Only one case showed failure and the failure was due to a re-rupture at the sutured area. Complications of ACL reconstruction or meniscus repair were not present.

Conclusions

The results demonstrate that arthroscopic all-inside repair using the Meniscal Viper Repair System is an effective treatment method when it is performed simultaneously with ACL reconstruction.     

Medial meniscus posterior root repairs: A comparison among three surgical techniques in short-term clinical outcomes and arthroscopic meniscal healing scores

BackgroundMedial meniscus (MM) posterior root repairs lead to favorable clinical outcomes in patients with MM posterior root tears (MMPRTs). However, there are few comparative studies in evaluating the superiority among several pullout repair techniques such as modified Mason–Allen suture, simple stitch, and concomitant posteromedial pullout repair. We hypothesized that an additional pullout suture at the MM posteromedial part would have clinical advantages in transtibial pullout repairs of the MMPRTs. The aim of this study was to compare the clinical usefulness among several types of pullout repair techniques in patients with MMPRTs.MethodsEighty-three patients who underwent arthroscopic pullout repairs of the MMPRTs were investigated. Patients were divided into three groups using different pullout repair techniques: a modified Mason–Allen suture using FasT-Fix all-inside meniscal repair device (F-MMA, n = 28), two simple stitches (TSS, n = 30), and TSS concomitant with posteromedial pullout repair using all-inside meniscal repair device (TSS-PM, n = 25). Postoperative clinical outcomes and semi-quantitative arthroscopic meniscal healing scores (0–10 points) were evaluated at second-look arthroscopies.ResultsNo significant differences among the three groups were observed in patient demographics and preoperative clinical scores, except for preoperative Lysholm scores. At second-look arthroscopies, there were no significant differences among the three techniques in postoperative clinical outcomes and meniscal healing scores.ConclusionsThis study demonstrated that the TSS-PM pullout repair technique did not show better scores in postoperative clinical outcomes and meniscal healings compared with the F-MMA and TSS techniques. Our results suggest that the concomitant posteromedial pullout suture may have no clinical advantage in the conventional pullout repairs for the patients with MMPRTs.     

Is meniscal repair an adequate procedure to prevent early osteoarthritis in athletes with chronic anterior knee instabilitity?

We retrospectively evaluated the clinical outcome of arthroscopic assisted meniscal suture repair in athletes on different competitive sports levels with stable joint function and persisting anterior knee instability. Return to former sports levels and early osteoarthrotic changes were especially focussed. Examination included 50 athletes (32 men, 18 women) who underwent meniscal repair in inside-out technique during the period of 1989 to 1998. 23 patients had isolated full-thickness meniscal tears, 27 an associated rupture of the anterior cruciate ligament which was reconstructed in 13 cases with a patellar-tendon autograft. 3 study groups were formed referring to the athletes preoperative sports level evaluated with Tegner's score. Reexamination included Lysholm score, IKDC score and Fairbank's score. With a mean age of 32.1 years (range 13-53 years) and an average follow-up of 6.3 years 72 % of the patients (n = 36) showed a stable joint function on reexamination. With no persisting anterior knee instability 86 % of the professional athletes returned to former full sports activities on competitive levels. Non competitive athletes returned in all cases (100 %) to their former level. Fairbank's score increased by 0.1 observing minimal osteoarthitic signs. However, persisting anterior knee instability showed on reexamination poor results. Only one third of all athletes were able to return to former activity levels. Osteoarthritic changes were observed in all patients. Professional athletes had the most severe osteoarthritic changes with a significant (p = 0.03) increase of 0.8 in Fairbank's score. The results demonstrate that complete recovery on sports activities after meniscal repair is not possible without reconstruction of the anterior cruciate ligament. Isolated meniscal repair shows poor results in persisting anterior knee instability and does not prevent increasing osteoarthritic changes in athletes.     

Arthroscopic meniscal repair with two-year follow-up: a clinical review

The potential for healing of meniscal tissue has been historically underappreciated, but is currently more widely acknowledged. We have reviewed our experience with arthroscopic meniscal repair in 29 patients who had had a minimum of 2 years' follow-up. Between September 1983 and November 1986, 31 patients who had undergone arthroscopic meniscal repair with a minimum of 2-years' follow-up were identified. Of the 31 patients, 29 were available for additional follow-up. The patient population averaged 31 years of age, with 15 men and 14 women. Utilizing a closed arthroscopic cannulated technique, 16 lateral and 15 medial menisci were repaired. The majority of lesions were vertical bucket-handle tears involving the posterior horn and averaged 2.5 cm in length. Of the 31 tears, 29 were in the red-red or red-white zones. Clinical healing was present in 27 (87%) of the 31 repaired menisci. Nine patients underwent relook arthroscopy at which time healing was confirmed in eight, and a retear noted in one. Four reruptures occurred and the menisci required removal. Of the 29 patients, 16 had concomitant anterior cruciate ligament injuries ranging from partial tears to complete disruptions. Seven patients underwent immediate or delayed anterior cruciate ligament stabilization. Healing occurred in six of the seven patients whose anterior cruciate ligaments had been reconstructed. Among those patients with reruptures, chronic anterolateral rotatory instability was identified as a significant risk factor for rerupture. A complication rate of 13% was noted. Three patients underwent manipulation under anesthesia for postoperative ankylosis and one patient experienced a transient saphenous nerve neuropraxia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Arthroscopic revision of Bankart repair

The success of revision surgery for failed Bankart repair is not well known. This purpose of this study was to report the success rates achieved using arthroscopic techniques to revise failed Bankart repairs. Twelve arthroscopic revision Bankart repairs were performed on patients with recurrent unidirectional shoulder instability after open or arthroscopic Bankart repair. Follow-up was available on 11 of the 12 patients at a mean of 34.4 months (range, 25-56 months). The surgical findings, possible modes of failure, shoulder scores (Rowe score, University of California Los Angeles [UCLA], Simple Shoulder Test), and clinical outcome were evaluated. Various modes of failure were recognized during revision arthroscopic Bankart repairs. Good-to-excellent results were obtained in 8 patients (73%) undergoing revision stabilization according to Rowe and UCLA scoring. A subluxation or dislocation event occurred in 3 (27%) of the 11 patients at a mean of 8.7 months (range, 6-12 months) postoperatively. Arthroscopic revision Bankart repairs are technically challenging procedures but can be used to achieve stable, pain-free, functional shoulders with return to prior sport. Owing to limited follow-up and the small number of patients in this study, we were unable to conclude any pattern of failure or selection criteria for this procedure.     

Arthroscopic repair of full-thickness tears of the rotator cuff: 2- to 14-year follow-up

Purpose: This study was performed to evaluate 2 arthroscopic techniques for rotator cuff repair used by 1 surgeon for more than 12 years. The main objective of this study was to test the reliability of these arthroscopic repair techniques not only using clinical assessment during the follow-up, but through observation of the healing process of the tendons during the arthroscopic removal of the staples in our first group of patients. Type of Study: This study was a before/after trial. Methods: We present the results of arthroscopic repair of full-thickness rotator cuff tears in 100 patients. In group I, 35 patients had staple fixation, and in group II, 65 patients had side-to-side suture and anchor repair. Follow-up ranged from 2 to 14 years. All shoulders were evaluated using the UCLA rating scale. Shoulders repaired with staples (group I) were evaluated arthroscopically at staple removal. Arthroscopic subacromial decompression was performed in 26 of the 35 patients in group I and in 65 of the 65 patients in group II; 58 patients in group II had concomitant resection of distal clavicle. Results: In group I, 22 patients (63%) had excellent results (UCLA scores, 34-35), 7 (20%) had good results (UCLA scores, 28-33), 4 (11%) had fair results (UCLA scores, 21-27), and 2 (6%) of the patients had poor results (UCLA scores, 0-20). In group II, 47 patients (72%) had excellent results (UCLA scores, 34-35), 12 (19%) had good results (UCLA scores, 28-33), 2 (3%) had fair results (UCLA scores, 21-27), and 4 (6%) of the patients had poor results (UCLA scores, 0-20). Conclusions: Patients with well-healed rotator cuff tendons had satisfactory postoperative results and better overall functional results. The arthroscopic techniques for rotator cuff repair achieve results comparable to the results of traditional open repair. However, these technically demanding arthroscopic procedures require advanced arthroscopic skills and have a steep learning curve.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 2 (February), 2002: pp 136–144     

Patient outcomes following T-Fix meniscal repair and a modifiable,progressive rehabilitation program,a retrospective study

INTRODUCTION: This retrospective study presents clinical patient outcomes following meniscal repair using T-Fix devices and a modifiable, progressive rehabilitation program. MATERIALS AND METHODS: Fifty-two patients (35 males and 17 females) with a mean age of 26.7 years (range 13-50 years) representing all of the patients who underwent arthroscopic meniscal repair (43 medial meniscus, 12 lateral meniscus) over a 3-year period by the same surgeon (D.C.) (55 menisci) participated in this study. Thirty-two of the patients (62%) had an associated ACL tear. All patients with an ACL tear underwent reconstruction (tibialis anterior allograft) at the time of meniscal repair. All meniscal tears were located in either the red-red zone (29) or the red-white zone (26). All patients who underwent meniscal repair participated in a modifiable (based on meniscal tear size, type, and location) progressive rehabilitation program. Operative notes and photographs were reviewed to identify the meniscal tear location, tear type, tear length, and the number of T-Fix devices used. Orthopedic clinic and physical therapy reports were also reviewed for postoperative range of motion, knee joint effusion, knee joint pain, McMurray test findings, and single-leg broad-jump test performance (90% bilateral equivalence goal). The average postoperative clinical follow-up period was 10.3 months (range 4-24 months). RESULTS: Most (22/23, 96%) patients who underwent meniscal repair alone displayed excellent results. All patients (32/32, 100%) who underwent combined ACL reconstruction-meniscal repair displayed excellent results. During an acute event such as a sudden directional change while running or contact with another player, 5 of these patients re-injured their meniscus at the repair site in conjunction with tearing the reconstructed ACL at 12+/-3 months following the index surgical procedure. Each of these 1-2 cm meniscal tears had been previously repaired with two T-Fix devices. CONCLUSION: The T-Fix device used in combination with a modifiable progressive rehabilitation program produced excellent clinical patient outcomes among this patient group.     

Isolated meniscal repair in the avascular area

The authors present the results of a prospective cohort study carried out in young patients, to evaluate the outcome of meniscal repair in the avascular region of the meniscus. Forty five patients underwent either open (23 patients) or arthroscopic repair (22 patients) between 1982 and 1992. Seventeen men and eight women were included in the present study; their ages at the time of admission ranged from 16 to 27 years. They all presented with isolated longitudinal tears in the central avascular region of the meniscus. No patient with any kind of concomitant lesion was included in this series. The stitches were usually passed through the injured area and the synovium, and the knots were tightened outside the capsule. Twenty five patients of the total series, were subjected to a clinical examination in 1993, 9 to 54 months after meniscal suture. The Lysholm Knee Rating Score and the Tegner Activity Test were used. During 1999, these patients responded to a written questionnaire, based on the above mentioned rating scales. Among the 25 patients, there were 4 recurrences (16%), 2 fair results (8%) and one partial healing (4%). Eighteen (72%) patients, among which eight were treated using the arthroscopic technique, have shown favourable results, without any symptoms from the tibiofemoral joint, based on clinical examination and on the Lysholm Rating Scale and the Tegner Activity Test. When confronted with meniscal tears where there is doubt regarding the vascularity of the injured area, surgical repair in the avascular zone appears to provide a reasonable probability of healing, with good clinical outcome.     

关节镜下FasT-Fix系统修复半月板中期疗效观察

目的探讨关节镜下FasT-Fix系统进行半月板修复的临床效果。方法 2005年4月～2007年7月,32例(34侧)半月板损伤应用Fast-Fix系统(美国SmithNephew公司)进行了关节镜下全内镜下的半月板缝合,合并前交叉韧带断裂者同时用自体半腱、股薄肌腱进行前交叉韧带的单束或双束重建手术。评价半月板缝合后的临床愈合情况,并进行IKDC评分、Lysholm评分、Tegner评分。结果随访26～52个月(平均35个月),按照Barrett标准评价,30侧临床愈合,临床愈合率为88.2%(30/34)。IKDC评分由术前(45.3±18.7)分提高到术后(78.7±13.6)分(t=7.168,P=0.000),Lysholm评分由术前(43.5±22.2)分提高至术后(84.8±14.7)分(t=8.493,P=0.000),Tegner评分由术前(3.0±2.1)分提高至术后的(6.1±1.9)分(t=6.796,P=0.000)。结论应用Fast-Fix系统进行半月板缝合具有很好的中期疗效。     

应用Fast—Fix关节镜下修复半月板损伤

目的探讨Fast—Fix在关节镜下半月板损伤修复中的应用,并尝试对其手术技巧与疗效进行相关分析。方法选择本组59例在关节镜下应用Fast—Fix半月板缝合装置缝合的半月板撕裂的患者,其中陈旧性损伤31例,新鲜损伤28例,应用Fast—Fix缝合数目1～3个。术后根据MRI随访,并进行膝关节Lysholm评分及膝关节半月板损伤后JOY疗效评分。结果半月板平均缝合时间为5min。患者平均随访15个月,术后3个月MRI复查,半月板愈合率91％。术后患者的膝关节Lysholm评分、JOY疗效评分与术前比较,差异有统计学意义（t=5．215,P〈0．01）,疗效的优良率为89％。结论应用Fast—Fix在关节镜下行半月板撕裂缝合,方法简便,易于操作,固定牢靠,术后半月板愈合率高,是一种方便、有效的完全关节镜下半月板缝合技术。     

Arthroscopic meniscal repair: analysis of treatment failures

The rationale for meniscal repair is based on the importance of the meniscus in overall knee function and stability as well as the inferior results seen with meniscectomy. The high success rate usually seen with arthroscopic meniscal repair has made it the treatment of choice for peripheral meniscal tears. This study reviewed the records of patients who have failed meniscal repair surgery to gain greater understanding of the factors that may predispose a patient to a failed outcome. From 1987 to 2002, three hundred meniscal repairs were performed (203 medial and 97 lateral). Thirty-seven patients had failed meniscal repairs. Records were available for 33 (89%) patients. The mean patient age was 25 years (range: 13-48 years) at the time of meniscal injury. The average initial tear size was 2.7 cm with a mean rim width of 2.3 mm. Eighty-eight percent occurred in ACL tears. The average time interval from initial repair to the recurrence of symptoms was 34 months. Patients who were older at the time of meniscal repair failed significantly later than those patients who were younger at the time of repair. With age stratification, those patients who were aged > or =29 years at time of meniscal repair failed at an average of 23 months. In contrast, patients who were aged > or =30 years at the time of repair failed at an average of 53 months. Larger initial tears failed significantly sooner than smaller tears. Initial tears with larger rim widths demonstrated a trend toward shorter time to failure. Patients who underwent combined ligament reconstruction with meniscal repair failed at an average of 37 months. Deficient ACLs that were treated with isolated meniscal repairs (ACL intact) failed at an average of 16 months.     

Bioabsorbable lag screw fixation of knee osteochondritis dissecans in the skeletally immature

Osteochondritis dissecans (OCD) of the knee in children is associated with more morbidity than previously recognized. Sixteen knees in 13 children with symptomatic OCD lesions in the knee diagnosed with MRI underwent arthroscopic fixation using polylactide biodegradable lag screws, after failing a minimum of 6 months conservative treatment. The mean age was 12.3 years; 14 lesions were in the medial condyle, two in the lateral condyle, and the mean area was 244 mm. Early physiotherapy was prescribed with no period of immobilization and the patients were followed for a mean of 27 months. One patient, who required a concomitant meniscal repair, developed a transient neurapraxia of the peroneal nerve but went on to full recovery. All patients but this one had returned to sport at 4-month follow-up. There was significant improvement in the knee function scores and all patients reported their knees as improved or much improved. We propose that simple arthroscopic fixation of OCD with SmartScrews is an effective treatment in the pediatric population leading to a rapid recovery of premorbid function.     

The meniscus suture. Results of a clinical and sonographic follow-up study

The goal of our clinical and ultrasonographic study was to evaluate the results of the patients who underwent meniscal suture between June 1983 and December 1987 in our clinic. 41 patients (82%) were examined by the author, the mean follow-up time was 40 months. The mean Lysholm score rate was 93.4 points. 72.9% were able to return to their former sports level. 3 patients were suggested to have recurrence, but this could not be proven by arthroscopic and ultrasonographic means. High grade congruency of clinical and sonographic examination was obvious as it was in the literature. The meniscal suture healed in 92.5% so we recommend the procedure if ever possible.